10060178 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7518 DUMAS DR CONTRACTOR:BAUTISTA BUILDERS PERMIT NO: 10060178
OWNER'S NAME: BALAUMALAKSHMI PADMANABAN 1365 JIJANITA WAY
DATE ISSUED:06/29/2010
JER'S PHONE: 4084462681
CAMPBELL,CA 95008 PHONE NO:(408)599-8401
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB
B,C39,e6i
License Class Lic.# 6 MECH RESIDENTIAL . COMMERCIAL
Contractor:� � Date TU.c� 2q. Z,,t o
JOB IIESCRIPTION:RE-ROOF REMOVE WOODSHAKE&SHINGLE,APPLY
I hereby affirm that I am licensed under the provisions of Chapter 9 RADIA NT
(commencing with Section 7000)of Division 3 of the Business&Professions BARRIER OSB SHEATHING,APPLY 30LBS FELT PAPER,
Code and that my license is in full force and effect. APPLY 40YR COMP SHINGLE,NEW ALUMINUM GUTTERS
I hereby affirm under penalty of perjury one of the following two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Valuation:$14500
permit is issued. Sq.Ft Floor Area:
APPLICANT CERTIFICATION 14i0--
I certify that I have read this application and state that the above information is APN Plumber:35926007.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Date:
Dat,:: V4- Z 7o w Issued
Signature c� y'
L, OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All to ofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, instal ed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) Signature of Applicant:,--41 — � Datet�,A_
I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code).
ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. I ha,a read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safei y Code,Section 25532(a)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,l shall cont:iminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's mair tain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must Owner r author' gent: S
forthwith comply with such provisions or this permit shall be deemed revoked.
P Y P P f�c� _ Date:,� ,4-��
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating I her-by affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
-unify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the Len lei's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18.
I un lerstand my plans shall be used as public records.
Signature Date
Licc used Professional
CITY OF CU PERTINO
FEE ESTIMATOR- BIJILDING DIVISION
ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: Iso
R�PERMITT`YPE: Minor Building Permit PLAN C HECK TYPE: Re-roof
PRIMARY SFD or Duplex TOTAL fFAFPLICATION
USE: ROOF AREA: .
E�KS. PE:
xW
xa
00
3 �
FEE ID
1REROOFFRES
77
NOTE. Theseees are based on the preliminary in ormation available and are only an estimate. Contact the De t or addn'l in o.
FEE ITEMS (Fee Resolution 09-051 F_ff. ?'/-'()9) FEE QTY/FEE MISC ITEMS
Permit Fee: $390.00
F71
Work Without Permit? Q Yes (E) No $0.00
Strom Motion Fee: $0.00 Select an Administrative Item
Bld .T Stds Commission Fee: $0.00
SUBTOTALS: $390.00 $0.00 TOTAL FEE: $390.00
Revised: 5/27/2010
rr ff (
CITY OF � C �~% Y� � l V
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION
Date:
Building Address:
S /Z '
Owner's Name:t�� FA Ll��;4�3 A Phone #:
u ��, c �_1�,►`� rn-� � 44,6 - -2,G I
HOA: Yes ❑ No [ I If ves, provide letter from HOA
Contractor: - _ Phone #(i.0> 5�9 -- � a
A % c-5,TA-
Fax#: 140S) -3-7o r7q oi'
Cupertino Business License #: `j Contractor License #:
Type of Roof Covering:
Existing: P eoposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
K Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#&` (�' - (4 7 S
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: �' ,n��v Woo'p .naR►�
~� L 'FELT PAP �M</
Y
Residential Commercial El
Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cul ertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY 01:
CITY OF CUPERTINO
REROIDF
CUPERT' l�+�O FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Group
Squares
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Resid-,ntial B 1SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-FamilyTB
1MFDWLROOF
1BCBSC Cal Bldg Standards ALL PERMIT TYPES
Commission:-ee1BSEISMICRE Seismic Residential
1BUSLIC Business Licimse B
J�
INPUT Res=es EnergyAD
M.Indoor Air Qualrty and Finishes
1.Use LowMo-VOC Paint 1 IAD-Health pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAQ Health pts y=yes p
3.Use Low/No VOC Adhesives 3 IAD Health pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Res)urce pts y=yes .0
5.Use Engineered Sheet Goods with no added Urea
Formaldehyde 6 IAQ Health pts y=yes p
6.Use Exterior Grade Plywood for Interior Uses 1 [AaHealth pts y=yes p
7.Seal all Exposed Particleboard or MDF 4 IAQ Health. pts y=yes p
8.Use FSC Certified Materials for Interior Finish 4 Res)urce pts y=yes 0
9.Use Finger-Jointed or Recycled-Content Trim 1 Res wrce pts y=yes 0
10.Install Whole House Vacuum System 3 IAC/Health pts y=yes p
1 1 !
N.Flooring = M
1.Select FSC Certified Wood Flooring B Reso irce pts y=yes 0
2.Use Rapidly Renewable Flooring Materials 4 Reso irce pts y=yes 0
3.Use Recycled Content Ceramic Tiles 4 Reso irce pts y=yes 0
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Iiealth pts y=yes p
5.Use Exposed Concrete as Finished Floor 4 Reso irce pts y=yes 0
6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0
Total Points Avallable:1 1 1401 130 57
Total Points Project Received: 1 01 01 0
G
G:data/progs/greenbuildingt fuidelines/remodelers/greenpointsfinal2.12.o4protected.xis
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
CU PERTI NO Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: pt2- PERMIT#
OWNER'S NAME: ,t V,1,4N�-9FAA) PHONE # 40 6 "O1 6 $
GENERAL CONTRACTOR: A,�,'k15(vA �►t-- vl2-� BUSINESS LICENSE#
ADDRESS:(36 c:moi i CITY/ZIPCODE:
*Our municipal code requires all bu nesses working in thu city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. � � � -- 2
!L ,�y�ti c?i 17
I am not using any subcontractors: Date
Signature
Please check applicable subcontractors and complete the following information:
&/ SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring/ Carpeting
Linoleum /Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Painting/Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date